Bob Flaws, Dipl. Ac. & C.H., FNAAOM
INTRODUCTION
Based on my 20 years of clinical experience and research, Li Dong-yuan's yin fire theory is one of the most important theories within Chinese medicine for the treatment of "difficult to treat, knotty diseases." Li Dong-yuan was one of the Four Great Masters of the Jin-Yuan dynasties and arguably the greatest of these four. Chinese medicine made a huge conceptual leap forward during these two dynasties. From the end of the Han dynasty until the Jin-Yuan, no significant new theories were added to Chinese medicine. However, due to the influence of Neo-confucianism in the Song dynasty, some extremely important new theories and prac-tices were added to Chinese medicine during the Jin and Yuan dynasties. Therefore, the Chinese medicine developed during this time period is often referred to as "Jin-Yuan medicine" or also as "Li-Zhu medicine" after the two most important medical thinkers of this time, Li Dong-yuan and Zhu Dan-xi.
YIN FIRE & ITS DISEASE MECHANISMS
Of the new theories developed in the Jin-Yuan dynasties none is more important than Li Dong-yuan's concept of yin fire. Yin fire refers to an evil heat, often damp in nature, which develops from the lower burner but which then counterflows upward. This theory of yin fire is found in Li's magnum opus, the Pi Wei Lun (The Treatise on the Spleen & Stomach). If one looks at every instance in this monumentally important book (available in English as part of Blue Poppy's Great Masters Series) where Li describes various disease causes and mechanisms of yin fire, we can identify five basic causes of this condition. These are:
1. Spleen qi vacuity
2. Damp heat
3. Liver depression, depressive heat
4. Yin & blood vacuity
5. Stirring of ministerial fire
Although we must explain these one after the other in a linear fashion, the reader should understand that these five disease mechanisms are all mutually interdependent. This means that any one of these mechanisms can result in the creation of any of the others. Because of this, real-life patients do not typically exhibit only one or another of these five, but rather three, four, or all five at one time. However, Li begins his explanation of yin fire with the spleen, and that is where we will also begin.
If, due to over-thinking, anxiety and worry, under-exercise, over-taxation, faulty diet, or erroneous medical treatment, the spleen qi is damaged and become vacuous and weak, then the spleen will not be able to do its various duties and functions. One function of the spleen is to control water liquids in the body, moving and transforming these. If the spleen qi becomes vacuous and weak and, thus, cannot move and transform water liquids, these may gather and accumulate and transform into dampness. This dampness may then hinder and obstruct the free flow of yang qi. Because yang qi is inherently warm, it too becomes stagnant and depressed. The yang qi backs up and transforms into depressive heat. If this depressive heat mutually binds with accumulated dampness, this will give rise to damp heat. Although this damp heat may be engendered in the middle burner, dampness, being turbid and heavy, typically percolates downward to the lower burner. However, because heat is yang, it tends to counterflow upward. If this heat counterflows upward, it may damage yin fluids and the qi of the spleen, stomach, heart, and/or lungs.
If, due to unfilled desires or anger damaging the liver, the liver loses its command over coursing and discharge, the liver will become depressed and the qi become stagnant. Once again, because the qi is inherently yang and, therefore, warm, qi depression may transform into depressive heat. These heat evils will also counterflow upward to accumulate in and damage the spleen, stomach, heart, and/or lungs. Because liver depression is a repletion and replete liver wood may counterflow horizontally to assail the spleen, liver depression typically results in concomitant spleen qi vacuity.
If, for any of the above reasons, the spleen becomes vacuous and weak, it may also not engender and transform blood adequately. This may then give rise to blood vacuity. Blood and essence share a common source. This means that the liver and kidneys share a common source. Great or enduring blood vacuity may eventually reach the kidneys, resulting in kidney yin vacuity. If yin become insufficient to control yang, then yang may become hyperactive and also ascend. In addition, it is the blood which nourishes the liver. The Nei Jing (Inner Classic) says that when the feet obtain blood, the feet can walk. When the hands obtain blood, the hands can grasp. When the eyes obtain blood, the eyes can see. And when the ears obtain blood, the ears can hear. This means that the function of any tissue or organ in the body is dependent on adequate nourishment by blood. If the spleen fails to engender and transform adequate blood, then the liver may be deprived of its nourishment. If the liver fails to obtain blood, then it cannot do its duty of coursing and discharging the qi. Therefore, liver blood vacuity leads to or aggravates liver depression qi stagnation. If this liver depression transforms into heat or fire, it can then eventually evolve into liver yang ascendant hyperactivity or vacuity heat.
The Nei Jing also states that ministerial fire, another name for lifegate fire, is only healthy and helpful in the body if it remains level or calm. The Chinese character for level or calm is ping ( ). Whenever the word ping is used in a Chinese medical context, it means calm but also something more than the abstract concept of calmness. The word ping also means something that is level or flat in space. This is the opposite of something sticking or counterflowing upward. So when the Nei Jing says that ministerial fire is only healthy when it remains level, this means that it is only healthy and helpful when it remains in the lower burner. If it stirs, this is the opposite of calmness and stillness, and when the ministerial or lifegate fire stirs, it stirs upward.
What can cause such upward stirring of ministerial or lifegate fire? According to Li Dong-yuan, damp heat pouring downward can damage the liver and kidneys and also the large intestine and cause upward stirring of lifegate fire. However, any stirring can cause the ministerial fire to stir. As Zhu Dan-xi went on to explain, any excessive mental, emotional, or physical stirring or activity can stir the lifegate fire. In particular, "sex, drugs, and rock 'n roll" all stir the ministerial fire and lead it to counterflow upward.
Although most Westerners know that lifegate fire is synonymous with kidney yang or kidney fire, few also know that lifegate fire is larger than just kidney yang. Lifegate fire is the root of all yang in the body. This means that the yang qi of all the viscera and bowels join in and partake of the ministerial fire. If the yang qi in any viscera or bowel becomes hot or hyperactive for any reason, this may cause upward stirring of ministerial fire. This is called xiang sheng or mutual engenderment in Chinese. The reader should here remember the saying that, "The seven emotions when extreme may all transform into fire." According to yin fire theory, this implies that any extreme emotion may also stir ministerial fire.
If the ministerial fire counterflows upward, several things may happen. First, Li says that the ministerial fire and the spleen qi are mutual enemies. In the Pi Wei Lun, Li says that the ministerial fire and spleen qi cannot both exist in the same place. Therefore, if the ministerial fire stirs upward, it may, and commonly does, damage the spleen qi. Second, if ministerial fire stirs upward, it may lose its root in its lower source. This means that upward stirring of ministerial, or lifegate, fire may leave the lower burner vacuous and cold below, while heat accumulates above. And third, if heat accumulates above, it will typically consume stomach yin, lie deeply or hide in and damage the lungs, and/or cause restlessness of the heart spirit.
Conversely, one way of preventing upward stirring of ministerial fire is to keep the spleen fortified and strong. According to Li, if the spleen qi is healthy and strong, then earth qi, i.e. dampness, will not pour downward to damage the kidneys and stir the lifegate. Another way of preventing upward stirring of ministerial fire is to keep the clear qi's upbearing and the turbid qi's downbearing freely flowing, and this immediately implies maintaining the liver's coursing and discharging of the qi.
THE COMPLICATIONS OF YIN FIRE
Therefore, it is easy to see that any one of the five basic mechanisms enumerated above can give rise to or aggravate any of the others. Then, because the qi is responsible for moving not only water liquids but also blood and food within the body, spleen qi vacuity and/or liver depression qi stagnation may be complicated by blood stasis and/or food stagnation. If dampness endures and congeals, it may transform into phlegm. Since static blood, stagnant food, and congealed phlegm are all yin substances, they may all hinder and obstruct the free flow of qi and thus cause or aggravate transformative or depressive heat or fire.
Because the spleen qi is the source of the lung qi, spleen qi vacuity may lead to a defensive qi vacuity and easy invasion by external evils. Because the heart spirit is nothing other than an accumulation of qi in the heart nourished by blood and the spleen is the latter heaven or postnatal root of qi and blood transformation and engenderment, spleen qi vacuity may easily give rise to heart qi and/or blood vacuity with concomitant disquietude of the spirit. In addition, if the ministerial fire stirs upward and yang qi loses its root in its lower source, this means that yang qi will not move and warm the blood in the lower burner. Due to vacuity cold, this may also give rise to blood stasis below. Because static blood is also called dead or dry blood and impedes the creation of new or fresh blood, static blood usually leads to or aggravates blood vacuity, and round and round we go.
All this means that yin fire scenarios are typically complicated by the presence of external evils, deep-lying or hidden evils, or retained evils, phlegm congelation or nodulation, food stagnation, etc. Yin fire scenarios, therefore, are not just made up of the five basic patterns or mechanisms listed above but usually involve at least some other externally invading or internally engendered evil qi. The above explanations should also not be taken as categorically complete. They merely serve to indicate some of the main, most obvious complications of the five basic disease mechanisms identified by Li Dong-yuan as the root of yin fire.
THE TREATMENT OF YIN FIRE
When it comes to treating yin fire, it is like Alexander the Great and the Gordian Knot. When Alexander was in Anatolia (present-day Turkey), he was presented with the Gordian Knot and told that whoever was able to untie this knot would rule all of Asia. Many had tried, but all before Alexander had failed. Whenever one pulled on one side of this knot, it tightened up somewhere on the other side. Alexander pondered this problem for a bit, then drew his sword, and cut the knot in two all in one stroke. Yin fire scenarios must be managed in Chinese medicine with much the same technique. If one looks at the majority of Li's formulas in his two greatest books, the Pi Wei Lun and the Lan Shi Mi Cang (The Orchid Chamber Secret Treasury), one can identify five basic principles Li used to treat multi-pattern yin fire conditions (I am indebted to my good friend, Charles Chace, who first identified these five principles in this way). These five principles are:
1. To fortify the spleen and boost the qi so that the clear can be upborne and the turbid downborne. Medicinally, it is sweet, warm medicinals which mostly do this.
2. To disinhibit the qi mechanism and promote the free flow of upbearing and downbearing. Medi-cinally, this is primarily accomplished by acrid, qi-rectifying, exterior-resolving medicinals.
3. Clear whatever kind of evil heat is present. Medicinally, this mainly implies using at least some bitter, cold medicinals.
4. Identify whatever disease mechanisms are also at work and also use ingredients which rebalance those mechanisms. Therefore, if there is blood stasis, use blood-quickening medicinals. If there is phlegm, use phlegm-transforming medicinals. If there is disquieted spirit, use spirit-quieting medicinals, etc. In other words, do whatever else is necessary.
5. Determine the relative strengths and priorities between the above four principles and compose your treatment plan accordingly. This means that one may not start as the basis of their treatment with a qi-supplementing formula. If heat is the main thing, then the guiding formula will probably come from the heat-clearing category. However, in that case, if there is truly a yin fire scenario, the formula will need to be modified with at least some spleen-supplementing and liver-rectifying medicinals. Likewise, if the main condition is blood stasis but blood stasis occurs within a yin fire pattern, then one may begin with a blood-quickening formula but then modify that with the probable inclusion of spleen supplements, heat-clearers, and liver-rectifiers.
In other words, although one may or may not start off with a spleen-fortifying formula, spleen fortification will be part of the treatment plan. Although one may or may not start off with a qi-rectifying formula, coursing the liver and rectifying the qi will be part of the treatment plan. Although one may or may not start off with a heat-clearing formula, bitter, cold, heat-clearing medicinals will be part of the treatment plan, plus anything else that is necessary to remedy and regulate all the disease mechanisms and their major symptoms.
When faced with difficult, multi-pattern cases, many Western practitioners attempt to treat one pattern after another based on the model of "peeling the layers of an onion." This theory, however, is not found in the Chinese medical literature. It is a Western homeopathic theory based, at least in part, on Herring's Law of Cure. In Chinese medicine, patterns are not layers or levels. As we have seen above, the key mechanisms of yin fire are all xiang sheng, mutually engendering. Therefore, they must all be dealt with at the same time or the remaining mechanisms will only re-establish the mechanism one attempted to eliminate.
Many Western practitioners have had the experience similar to myself of treating only one facet of a complicated case. For a time, some of the signs and symptoms may go away, but eventually they all come back again. Then we re-examine the patient and decide that, in fact, the patient really has this pattern. We now treat that pattern and again some of their signs and symptoms disappear. After a few weeks, all the symptoms come back again. Again we re-examine the patient, and again we see some new part of the condition that we attempt to treat as a discreet pattern. This may go on for months until either the patient loses their patience and they simply do not come back anymore, or we lose any sense of understanding the case.
In such complicated, multi-pattern yin fire cases, one must treat the whole condition as a single, multifaceted pattern. Until or unless one tries to treat all the disease mechanisms at one time, any improvement in the patient's condition can only be temporary. Therefore, when treating such multi-pattern yin fire scenarios, one's formula will have to include medicinals from at least three, and probably even more, categories. There will be some supplementing, supporting medicinals and some attacking, draining medicinals. There will be some warm medicinals and some cold medicinals. There will be some qi-rectifying medicinals, and there will be medicinals from at least one other category.
In real-life practice with complex Western patients suffering from chronic diseases that are not self-limiting and no one else previously has been able to treat, one simply has to use very complex Chinese medicinal formulas. In China, such cases are typically reserved for the lao yi sheng or old Chinese doctor with 20, 30, 40, or 50 years clinical experience. However, in the West, most patients coming for treatment with Chinese medicine suffer from such "difficult to treat, knotty diseases." If one reads the 20 or so Chinese medical journals published in the People's Republic of China each month, one will see that Li Dong-yuan's theory of yin fire is the most commonly used theory to treat such "difficult to treat, knotty disease" in the PRC today. Likewise, it is my experience that Li's formulas, as found in his Pi Wei Lun and Lan Shi Mi Cang, form one of the best models for treating complex, multi-pattern Western patients suffering from chronic diseases. In particular, yin fire theory is extremely useful when dealing with allergies of all types, autoimmune disorders of all types, various types of chronic viral conditions, various types of parasites, intestinal dysbiosis, leaky gut syndrome, and candidiasis.
In terms of chronology, Li was historically the third of the Four Great Masters of the Jin-Yuan dynasties. The fourth and last was Zhu Dan-xi. Although Zhu is remembered as the founder of the School of Enriching Yin, Zhu basically accepted all of Li's teaching and methods. However, Zhu saw that evil heat, no matter what its cause, if it is enduring, will damage yin fluids. Therefore, he used Li's formulas but was sure to add or include some ingredients which would nourish and enrich the blood or stomach, lung, and/or heart yin. Likewise, Gong Ding-xian, the author of the eighteenth century Wan Bing Hui Chun (Restoring Spring to the Tens of Thousands of Diseases), created many complex hot and cold, supplementing and attacking formulas which are just right for dealing with many typical Western patients. Although Gong had his own theories about the cause and treatment of disease, if one analyzes the ingredients in most of his formulas, one can clearly see they embody Li's five treatment principles outlined above. Therefore, it is my experience that Zhu Dan-xi and Gong Ding-xian's formulas are also excellent models when treating yin fire patients.
BLUE POPPY FORMULAS & YIN FIRE
Most Blue Poppy Formulas are based on Li's yin fire theories and his, Zhu's, and Gong's formulas described above. These theories do not absolve practitioners of doing a careful, point-for-point pattern discrimination. What these theories say is that most patients with chronic diseases suffer from the same core set of disease mechanisms and that there are definite relationships between these sets of mechanisms. If, after doing a careful pattern discrimination, you find that your patient exhibits all the signs and symptoms of a multi-pattern scenario including spleen qi vacuity, liver depression qi stagnation, and some kind of heat, then you should seriously consider using one of Blue Poppy Herbs' formulas. On the explanation sheets for each individual formula, you will find the combination of signs and symptoms indicating each Blue Poppy Herb formula. If your patient has this same constellation of signs and symptoms, then you might want to try the appropriate Blue Poppy capsule. If your patient's case is even more complex, there are also suggestions for combining these capsules with other commonly available Chinese ready-made or "patent medicines." For more information on Li Dong-yuan's yin fire theory and how it applies to modern Western clinical practice, please see the following articles on this site
Allergies, Autoimmune Diseases & Yin Fire
Intestinal Dysbiosis, Leaky gut syndrome, Candidiasis & Yin Fire
Gu Parasites & Yin Fire
A Discussion of Mume & Perilla
Zhu Dan-xi on gu Conditions
Chinese Articles Advocating the Use of Li Dong-yuan's Ideas
Damp Heat & Hardening the Kidneys
These articles, written and/or translated by Bob Flaws, further explore the theoretical and clinical ramifications of Li Dong-yuan's yin fire theory and how this theory relates to Blue Poppy Formulas.
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